Healthcare Provider Details

I. General information

NPI: 1588331045
Provider Name (Legal Business Name): JORDAN GELHAUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 BRICE RD STE C
REYNOLDSBURG OH
43068-2796
US

IV. Provider business mailing address

1649 BRICE RD STE C
REYNOLDSBURG OH
43068-2796
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-5878
  • Fax:
Mailing address:
  • Phone: 614-300-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: